Background: Tracheostomy in children remains controversial regarding the ri
sk of complications.
Methods: Forty-six trauma patients (35 male and 11 female, mean age = 6.8 y
ears) were admitted to the intensive care unit between 1987 and 1991 with s
evere head injury plus coma. Tracheostomy was performed with standard techn
ique after 5.9 days (range, 2-12 days) of intubation,
Results There were no deaths from tracheostomy, but six deaths resulted fro
m severe head injury. One child was discharged with tracheostomy, The 39 su
rvivors remained with tracheostomy 16.14 days (range, 4-71 days) in the int
ensive care unit. After cannula removal, 31 remained asymptomatic; 8 had re
spiratory distress: 2 were normal, 5 had endoscopic treatment for subglotic
granulomas/stenosis from intubation, and 1 had tracheomalacia from tracheo
stomy, In 1997, the 18 patients located for follow-up were asymptomatic. At
endoscopy, 8 were normal, 9 had subglottal granulomas from intubation, and
1 had 20% tracheal stenosis from tracheostomy,
Conclusion: Most complications after tracheostomy result from intubation, T
racheostomy has an acceptable risk in children with severe head injury who
need prolonged ventilatory support.